Advances in dry eye management improve healing after LASIK
Optometrists are well-equipped to assess and manage patients during their post-LASIK follow-ups.
The most common finding during the first several months after LASIK is dryness, which can be successfully managed with effective treatment options.
From immunomodulators such as Xiidra (lifitegrast, Novartis) that reduces inflammation and helps produce better quality tears, to the reformulated Restasis Multidose (cyclosporine, Allergan) that enhances patient compliance, to intranasal neurostimulators such at TrueTear (Allergan) that triggers patient’s own tear production, we can help our patients heal faster.
The efficacy of modern dry eye management is supported by recent research.
At the 2019 American Society of Cataract and Refractive Surgery (ASCRS) meeting, a study by Schallhorn et al dispelled many dry eye myths.8 Preop dry eye did not translate to post-op dry eye, and in fact, some patients with moderate to severe dry eye experienced less ocular surface disease symptoms after LASIK.
The results of the Patient-Reported Outcomes with LASIK (PROWL) studies launched by the FDA, the National Eye Institute, and the Department of Defense have also concluded that with modern pre- and post-LASIK dry eye management patients experience excellent outcomes.
These studies revealed that in most patients, preoperative dry eye symptoms decreased after LASIK. Even though some patients experienced new dry eye symptoms at three months, these were categorized as mild and improved with time and ocular surface management.6
Related: Overlooked causes of dry eye
Advances in surgical customization are likely to continue with more patients able to achieve vision beyond 20/20.
The SMILE procedure is promising, but it needs to incorporate treatment of higher-order aberrations to achieve the same level of customization as modern LASIK surgery.
The concept of presbyLASIK may continue to be explored to improve both distance and near vision in presbyopic patients while minimizing side effects of a multifocal cornea.
Novel therapeutic approaches to stimulating corneal nerve regeneration and restoring corneal nerve function and sensitivity are being investigated. Nerve growth factor, Cenegermin-containing eye drops (Oxervate, Dompé) have been FDA approved for the treatment of neurotrophic keratitis. Further investigation could help determine if such types of medications could enhance healing after LASIK.
We have come a long way in the past 30 years.
1. Free Patents Online. Method for Modifying Corneal Curvature. Available at: http://www.freepatentsonline.com/4840175.pdf. Accessed 10/7/19.
2. McAlinden C. Corneal refractive surgery: past to present. Clin Exp Optom. 2012 Jul;95(4):386-98.
3. Reinstein DZ, Archer TJ, Gobbe M. The history of LASIK. J Refract Surg. 2012 Apr;28(4):291-8.
4. Bloomberg Business. LASIK Surgery: How IBM’s Dr. James Wynne Discovered It. Available at: https://www.youtube.com/. Accessed 10/7/19.watch?v=yzavwVLefPw
5. Sandoval HP, Donnenfeld ED, Kohnen T, Lindstrom RL, Potvin R, Tremblay DM, Solomon KD. Modern laser in situ keratomileusis outcomes. J Cataract Refract Surg. 2016 Aug;42(8):1224-34.
6. Eydelman M, Hilmantel G, Tarver ME, Hofmeister EM, May J, Hammel K, Hays RD, Ferris F 3rd. Symptoms and Satisfaction of Patients in the Patient-Reported Outcomes With Laser In Situ Keratomileusis (PROWL) Studies. JAMA Ophthalmol. 2017 Jan 1;135(1):13-22.
7. Moshirfar M, Shah TJ, Skanchy DF, Linn SH, Kang P, Durrie DS. Comparison and analysis of FDA reported visual outcomes of the three latest platforms for LASIK: wavefront guided Visx iDesign, topography guided WaveLight Allegro Contoura, and topography guided Nidek EC-5000 CATz. Clin Ophthalmol. 2017 Jan 4;11:135-147.
8. Schallhorn J. Challenging conventional wisdom about LASIK. Presented at: American Society of Cataract and Refractive Surgery annual meeting; May 3-7, 2019; San Diego.
9. Optical Society of America. How a leftover Thanksgiving dinner gave us LASIK surgery. Available at: https://phys.org/news/2013-11-leftover-thanksgiving-dinner-gave-lasik.html. Accessed 10/7/19.